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A Survey on Neonatal Incubator Monitoring System

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International Conference on Physics and Photonics Processes in Nano Sciences IOP Publishing
Journal of Physics: Conference Series 1362 (2019) 012128 doi:10.1088/1742-6596/1362/1/012128

A Survey on Neonatal Incubator Monitoring System

Rajalakshmi.A1, Dr. K.A. Sunitha2, Dr. Revathi Venkataraman3

1,2,3
Department of Computer Science and Engineering, SRM INSTITUTE OF SCIENCE AND
TECHNOLOGY, Kattankulathur
[email protected],[email protected], [email protected]

Abstract--Recently many premature babies have lost their lives due to lack of proper monitoring of the
incubator that leads to accidents. A neonatal incubator is an enclosed equipment where a pre-
mature infant will be kept in a clean and controlled environment for observation and care. The biological
parameters are monitored to ensure the safety of the babies and to prevent death rates. For monitoring the
vital signs continuously for pre-mature infants in the hospital it requires sensors and electrodes which is
said to be kept in contact to the patient and it can be displayed in a d monitor. Any abnormality in the
parameter will be indicated by alarm system. In this survey, we concentrate on the available incubator
monitoring systems, the biological parameters measured and analyse techniques used in real-time
monitoring, transmission of the data.
Index Terms: NICU, Premature new-borns, IoT

1. Introduction
New-born babies who require special attention medically are admitted often to Neonatal Intensive
Care Unit (NICU). Most of the infants admitted in the NICU are said to be premature infants.
Premature infants are considered to be born before 37weeks of pregnancy, those who have low birth
weight which is lesser than 2.495 kilograms or they could have any medical condition which needs
special attention. Now-a-days NICU are well-equipped with advanced machines and devices to
monitor which are designed for the special requirement of the infants. Some of the monitoring
equipment often used in NICU are cardiorespiratory monitor, blood pressure monitor, temperature,
pulse oximeter, transcutaneous oxygen and carbon-di-oxide monitor, Ultrasound, X-Ray, Magnetic
Resonance Imaging, Respirator or Mechanical Ventilator. With Internet of Things, medical profession
has listed and technologists are trying to merge the various environment together to build a strong
monitoring system. Connecting things to internet with standard protocols and suitable architectural
changes expedites uninterrupted health monitoring for all day and any place. In this context various
incubator monitoring system for neonatal care are discussed in literature review.

2. INTENSIVE CARE REAL-TIME ANALYSIS

[34] Author has done a research approach collaboratively in order to address the necessity to analyse
patient’s data in real-time manner that is streamed to detect the significant medical conditions which
would indicate any medical complications. Author has stated the advantage from this system that the
patient gets benefited because of detecting th signs of the medical condition at the early stage may
provide earlier protection for the infants that improves patient’s outcomes potentially and the stay
length can be reduced.

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International Conference on Physics and Photonics Processes in Nano Sciences IOP Publishing
Journal of Physics: Conference Series 1362 (2019) 012128 doi:10.1088/1742-6596/1362/1/012128

3. CONDITIONS THAT AFECT INFANTS IN NICU

These are some of the conditions that affect the admitted infants in NICU.
A. Intraventricular Haemorrhage
Intraventricular Haemorrhage (IVH) causes morbidity and mortality for new-born infants. Almost 20%
of preterm infants who are under 1500g birthweight tend to develop an IVH. During the first few days
of life occurs Haemorrhage. Mostly it occurs during the third day from birth. Nearly 10% of IVHs is
occurred before the delivery. Extreme Immaturity, pneumothorax, birth asphyxia, sudden increase of
arterial blood pressure are the important risk factors for IVH.

B. Periventricular Leukomalacia
Periventricular Leukomalacia (PVL) means the white matter near the cerebral ventricles dies. PVL is
developed by 3-4% of premature infants, very low birth weight infants who weight 1500g and 3lb 5oz
and 4-10% of those born previously to 33 weeks of gestation. The white matter mentioned is said to
be the inner portion of the brain. The periventricular means the part of the white matter which will
surround the ventricles. Leukomalacia means it softens the white matter, which brain tissue death is
occurred quickly. PVL affects the new-born when they suffer from oxygen deprivation during labour,
delivery or at any time of birth. The variation of oxygen and carbon-di-oxide content in the blood
causes PVL. A stream analysis of the physiological data can detect these variations.

C. Nosocomial Infection
Infection are common and it is considered to be an important reason of morbidity and mortality
respectively for infants. Many infants get infection around the delivery time and also some infants may
say to acquire while in NICU care. Infections that acquired by hospitals are called as the Nosocomial
Infection. This is considered to be secondary to the original cause for the admission of the infant into
NICU. Detecting this infection at earlier stage is less possible because the clinical signs are vague and
non-specific till they become well established. Such infections occur in time period of 48hr or more
after the infant birth. They are not associated with mother. They are caused by the pathogens. Neonatal
network data indicates that 30% of infants those who are born at gestation of 25-28 weeks. More than
45% of infants who are born at the gestation before 25 weeks will face serious nosocomial infection
while in NICU. To reduce morbidity and mortality detection and intervention is expected to be done
earlier.

D. Pneumothorax
One to two percentage of all new-born infants have gas or air in pleural cavity. It separates the visceral
from parietal pleura. The lungs are said to be surrounded by a membrane. Its nature is to fold back on
itself. There are totally two layers attached to the lungs. One layer is attached to the chest wall and
another layer attached to the to the lungs. These layers will experience a movement when we inhale
and exhale. For the smooth movement of these layers, the membrane emits a fluid that is used for
lubrication. Pneumothorax occurs when some gas or air gets accumulated in-between the two layers.

Table 1: PARAMETERS CONSIDERED

S.NO PARAMETERS EXISTING SYSTEMS WITH THESE
PARAMETERS MONITERED
1 Infant Body Temperature 1. A monitoring system based on cloud and risk
management for premature new-borns

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International Conference on Physics and Photonics Processes in Nano Sciences IOP Publishing
Journal of Physics: Conference Series 1362 (2019) 012128 doi:10.1088/1742-6596/1362/1/012128

2. Alarm signals are transmitted in wireless manner

from incubators to neonatal nursing station
2 Incubator temperature 1. An Enhanced noise cancelling system for a
Comprehensive Monitoring and control of Baby
Environments
2. Temperature monitored IoT based smart
incubator
3. Baby Incubator
4. Real time central monitoring system for infant
incubator
3 Incubator Humidity 1. An Enhanced Noise Cancelling System for a
Comprehensive Monitoring and Control of Baby
Environments
2. Temperature monitored IoT based smart
incubator
3. Real time central monitoring system for infant
incubator
4 Infant body weight 1. Cloud-based monitoring system and risk
management for premature new-borns
5 Sound Cancelling 1. Design and Development of a Smart Baby
Monitoring System based on Raspberry Pi and Pi
Camera.
2. A Noise Cancelling System for a Comprehensive
Monitoring and Control of Baby Environments
6 Gas density adjustment 1. Intelligent infant incubator

The basic Vital signs are considered to be Temperature, Blood Pressure, Pulse rate and Respiratory
rate. The system [3] introduced by the author, detects the movements of the baby and produced sound,
specifically its crying. The output video which provides the baby’s current position is displayed on a
monitor where the infant kin can observe the baby’s movements while they are in distance from them.
As per the authors’ survey [4] he stated that the current available systems can control and monitor the
humidity, temperature and the light inside the baby’s room. In this published paper, author tends to
construct on the existing related work and provides a suggestion for an enhanced noise cancelling
system. It can be used to overcome sound pollution and also it can provide a comfortable environment
to the baby. It can comprehensively monitor and control. An enhanced system designed by Soukaina
Brangui [5] the author monitors the temperature and weight data in real-time. Cloud server is used to
store the data. A variety of warnings are provided regarding the health issues from the new-born’s
health state. The alert is pinged directly to mobile phones which are linked with this system. The
weight data are uploaded into the cloud server. A graphical Think Speak API is used and the uploaded
data is plotted. Saikat Sahoo1 [6] designed a system where the temperature of the infant and bed wet
detection is performed. An alarm indicates the high temperature, low temperature, if infant wets the
bed its high temperature and low temperature is indicated. When body surface temperature is varied it
is recorded and visualized using the LabVIEW program. Ashish.B [7] designed a incubator where the
temperature and the humidity of the incubator is monitored and maintained in a monitoring display
(laptop). This system is designed using Arduino and Raspberry pi. In a system proposed by Eugene T.
Puzio [8], the Incubator temperature is kept constant. If baby wets the bed, humidity transducer is
sensed, alarm is triggered by voice alarm, voice colour lamp and lets parents know. Real time central
monitoring system for infant incubator [12] is a system where the Temperature and humidity of the
incubator is measured. It is characterized in that, further comprising a sound and light alarm is
connected with the computer control unit by wire. The Components used are Computer display, large

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International Conference on Physics and Photonics Processes in Nano Sciences IOP Publishing
Journal of Physics: Conference Series 1362 (2019) 012128 doi:10.1088/1742-6596/1362/1/012128

screen display. In this system [22] main objective considered is the gas density adjusting means.
Components used are Surveillance camera, Pumping unit, Display.

4. NON-CONTACT SENSING
To monitor the vital signs continuously for pre-mature babies admitted in the hospital they require
sensors and electrodes which is said to be kept in contact to the patient and it can be displayed in a
monitor. When they are kept in contact with the skin it may induce stress, pain, irritation and can also
vandalize the skin surface of the infant which are delicate in nature. In this the author’s current study
is on monitoring of pre-term infants continuously. It has been performed for at least four days
consecutively, each of the Neonatal Intensive Care Unit (NICU). A video-based, non-contact methods
of monitoring is developed further. They are developed to acquire continuous estimation of heart and
respiratory rate, level of oxygen saturation in the babies who are placed inside incubators [2]. An
incubator named new born monitoring method based on IoT [19] performs Real-Time monitoring of
vital signs. Wrist strap is worn to baby with vital sign sensor module. If any vital sign abnormality
occurs, alarm is set-ON. RFID is used to detect the theft of baby. In this system [18] Sensors are placed
apart from the baby. Temperature and respiration are monitored. Sounds are cancelled. Components
used in this system are Camera, Microphone, and Speakers. All these three components are coupled
with computer network for remote monitoring of infants.

5. TECHNOLOGIES USED
Table 2: Technology used
S.NO TECHNOLOGIES EXISTING SYSTEMS WITH THESE
TECHNOLOGIES
1 PLC 1.Incubator system with monitoring and communication
capabilities
2.Multifunctional incubator for new-born baby

2 Wireless Transmission 1.Intelligent monitor incubator for infant

2. Network monitoring device for nursing baby
3. Remote Real-Time Monitoring and Analysis of
Neonatal Graduate Infants
4. Intelligent monitor incubator for infant heating
3 Zigbee Zigbee-based baby incubator temperature monitoring and
alarm system
4 CAN Bus driver Infant incubator monitoring device
5 Cloud A monitoring system based on cloud and risk management
for premature new-borns
6 Bluetooth Wireless Transmission Design for Health Monitoring at
Neonatal Intensive Care Units
7 PRD Motion based detection of respiration rate in infants using
video

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International Conference on Physics and Photonics Processes in Nano Sciences IOP Publishing
Journal of Physics: Conference Series 1362 (2019) 012128 doi:10.1088/1742-6596/1362/1/012128

A. PLC System
Neonatal Incubators has been designed using various technologies. Author Eugene T. Puzio [9] has
designed an incubator where the Temperature and humidity of the incubator and Skin temperature of
infant is measured. The Components used are Blue light lamps, Ventilation holes, controller, display
screen, control buttons and buzzer with PLC system and Wireless Transmission module. In real-time
manner, WIFI transmit monitoring data to the host computer located at a nurse station. In this system
called multifunctional incubator for new-born baby [11] the Temperature and humidity of the
incubator, Skin temperature of infant is measured. The Components used in this are Blue light lamps,
Ventilation holes, controller, display screen, control buttons and buzzer with PLC system and Wireless
Transmission module.

B. Wireless Transmission
In this system [10] is designed to humidify the chamber. A control box is connected by a wireless
manner with the camera, the control tank respectively further heating unit, and humidifier, a
temperature sensor and a humidity sensor are electrically connected. In this system [14] The skin
temperature of infant, temperature and humidity of the incubator, Oxygen and Carbon-di- Oxide
concentration in incubator weight, heartbeat, Blood pressure and oxygen saturation are monitored. All
these are transmitted to computer via network (internet). Infant Kin can observe their infant’s nursing
condition in their workplace or family by the network and det information in time. A computer is
authorized to browse and download the vision-frequency picture and monitoring data. Robert Greer
[33] has designed a system to monitor the new-born infant’s physiological data remotely outside
NICU. It is done by providing a simple mobile application where data can be monitored live. To
establish communication between vital sign monitor and the remote server Wi-Fi and 3G us used. In
[15] Real time monitoring of temperature and humidity of the incubator is done. If any abnormality
occurs,a alarm is sent to nurse station. The Components used are WIFI, Camera, Battery, Micro
Controller, Captive touch screen.

C. Zigbee technology
It is a high-level communication protocol which is used in low power digital radios and to create PAN.
Specification: IEEE802.15.4. In Zigbee-based baby incubator temperature monitoring and alarm [17]
incubator’s temperature is measured monitored and alarm can be realized. WSN constructed through
Zigbee is used.

D. CAN Bus driver technology

Controller Area Network is considered to be a robust vehicle bus which is a standard design and
provides communication without the host computer with each other in application. In infant incubator
monitoring device [21] CAN Bus driver technology is used. Temperature and Inferred Carbon-di-
Oxide is measured. Alarm is audible when monitor fails. Components used in this are Single
microchip, monitoring unit, CAN bus protocol converter, keyboard, display.

E. Cloud technology
Cloud computing enables Virtual Machine storage or an application instead of building computer
infrastructures. An enhanced system designed by Soukaina Brangui [5] the author monitors the
temperature and weight data in real-time. Cloud server is used to store the data. A variety of warnings
are provided regarding the health issues from the new-born’s health state. The alert is pinged directly
to mobile phones which are linked with this system. The weight data is uploaded into the cloud server.
A graphical Think Speak API is used and the uploaded data is plotted. The system developed by Saikat

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International Conference on Physics and Photonics Processes in Nano Sciences IOP Publishing
Journal of Physics: Conference Series 1362 (2019) 012128 doi:10.1088/1742-6596/1362/1/012128

Sahoo1[29] the vaccination and child’s growth is monitored in real-time and a application based on
cloud which is Integrated Child Health Record cloud (iCHR cloud) is used.

F. Bluetooth technology
Wei Chen [30] has designed system with wireless transmission technology.BlueSMiRF and Arduino
pro mini is used. A neonatal jacket is designed for the infant to monitor in non-invasively. The
system data are transmitted and received from multiple sensors within 20m range. Here a
temperature and LDR x2 is used and a display monitor is used for the display.

G. A fiber optic sensor for detecting respiration

New born normal respiratory rate is said to be 40 to 70 breaths per minute. Author Arika Dhia [31]
has reported a design of respiratory sensor using fiber optics technology for this incubator
application. This sensor functions based on the light intensity difference due to the thorax movement.
This movement is occurred during the respiration. The data is processed in Arduino Uno
microcontroller and it is measured real time and displayed in LCD. Author’s simulation result states
that the design is capable of measuring the respiratory rate, number of breaths from 10 to130 per
minute, the error rate of 0.595% and hysteresis error rate is 0.2%.

H. PRD
Author Daniel Myklatun’s system [32] the respiratory rate of the infant is monitored. It uses video
processing and video recording. Here a phase-based-respiration detection (PRD) has been tested on
small test set videos. It is performed on infants in asleep state where every breath is noted manually.
This is done by providing a truth signal. Author also states that PRD is more robust and promising
when compared with the difference-based method. PRD is tested on two adults. Then the respiratory
rate is compared to a truth signal which is obtained by pneumographic thorax. Author gives a
summary of the strength of their research and the Artemis which is the resulting environment in his
article.

6. INDICATIONS USED FOR ALARM

Systems were designed to sense and monitor the data. When any abnormality occurs according to the
given condition, it is notified by using alarm systems. Many types of alarms have been used. Following
are the system with types of alarms used for notifications online monitored new-born incubator [13]
is a prototype where it shoots the state of the baby inside the incubator and transmits the picture to the
monitoring main machine (MMM). The MMM is kept inside the monitoring room. If any abnormality
occurs, alarm is indicated through Short-Message Transmitting module (SMS) to nurse’s cell phone.
In this system [15] Real time monitoring of temperature and humidity of the incubator is done. If any
abnormality, alarm is sent to nurse station. The Components used are WIFI, Camera, Battery, Micro
Controller, Captive touch screen. Infant incubator and infant warmers with single patient and twin
patient control [16] the incubator’s temperature is monitored. Here manual mode may be used. Warmer
Skin: temperature of the infant is monitored. Alarm is triggered if temperature falls. Infant incubator
[20] is a prototype where real Time monitoring of infant’s physical condition is performed. If any
unexpected condition occurs, medical staff will be notified through alarm. Alarm used are Warning
lights and sirens. Components used are Monitor, camera, UV-germicidal lamp. Neonate warms up
case monitoring system [23] the temperature and humidity of the incubator, Vital signs are monitored.
Zigbee, 3G network are used. Real Time transmission is done. If any abnormality automatic alarm to
staff’s mobile with bed label and abnormal condition. Components used are Processing unit, Data
acquisition unit (DAU), Communication unit.

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International Conference on Physics and Photonics Processes in Nano Sciences IOP Publishing
Journal of Physics: Conference Series 1362 (2019) 012128 doi:10.1088/1742-6596/1362/1/012128

7. CHALLENGES IN DESIGNING NEONATAL INCUBATOR

One of the main challenges in designing an incubator is impact of emf. In this system [24] author has
stated that impact of emf on infant health is unclear. Hence system must be designed with minimum
emf exposure. This system [25] is an incubator which consist of a canopy. It controls an amount of
light selectively and is transmits into it. The light transmitted into the incubator is detected using
configured sensor. It is also to convert the transmitted light into electrical current further. Smart
incubator's glass (SIG) is used here. In this incubator [26] the Chamber’s movement is regulated up
and down. Chamber’s cover can be Open and Close. Temperature of chamber’s body is noted. In the
prototype Infant incubator [27] Hood’s speciality which is Non-closed cylindrical shell. In a system
called neonatal incubator [28] the author has concentrated on Sound Cancelling (i.e.) the external
sounds are cancelled.

8. CONCLUSION AND FUTURE SCOPE

On designing an incubator, the Impact of emf on infant health is unclear. Hence system must be
designed with minimum emf exposure. It can also be designed. The system must also be designed cost
effective manner with the ability to measure maximum parameters and efficient technology. Non-
Contact sensing od the parameters can be encouraged. Incubator can also be designed in portable
manner by considering energy efficiency and useful technologies.

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